Fractionated total lymphoid irradiation as preparative immunosuppression in high risk renal transplantation

Journal Article · Fri Oct 01 04:00:00 EDT 1982 · Ann. Surg.; (United States)

DOI:https://doi.org/10.1097/00000658-198210000-00007· OSTI ID:6255740

Najarian, J S; Ferguson, R M; Sutherland, D E; Slavin, S; Kim, T; Kersey, J; Simmons, R L

Twenty-two patients at high risk to reject renal allografts have been treated with fractionated total lymphoid irradiation (FTLI) prior to transplantation of primary (2), secondary (16) or tertiary (4) renal allografts. All patients undergoing retransplantation had rapidly rejected previous grafts. At 24 months following transplantation, 72% of grafts were functioning in the TLI group compared with a 38% graft function in an historical control group of recipients receiving secondary or tertiary grafts and treated with conventional immunosuppression. Important variables in determining success of transplantation following fractionated TLI include the dose of TLI, the interval from radiation to transplantation, and maintenance post-transplant immunosuppressive therapy. Optimal results were achieved with 2500 rads delivered in 100 rad fractions followed by transplantation within two weeks, and a tapering prednisone schedule and maintenance azathioprine post-transplantation. Seventeen patients had significant complications of the radiation treatment and there was one death, prior to transplantation, associated with pneumonitis. In vitro assessment of immune function demonstrated marked peripheral T cell depletion and loss of in vitro responsiveness to mitogen and allogeneic stimulation following FTLI. The administration of donor bone marrow at the time of transplantation did not produce chimerism. The results suggest that when properly utilized FTLI can produce effective adjunctive immunosuppression for clinical transplantation.

• Research Organization: Univ. of Minnesota, Minneapolis
• OSTI ID: 6255740
• Journal Information: Ann. Surg.; (United States), Journal Name: Ann. Surg.; (United States) Vol. 196:4; ISSN ANSUA
• Country of Publication: United States
• Language: English

Related Subjects

550603* -- Medicine-- External Radiation in Therapy-- (1980-)
560151 -- Radiation Effects on Animals-- Man
62 RADIOLOGY AND NUCLEAR MEDICINE
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
ADRENAL HORMONES
ANIMAL CELLS
ANIMAL TISSUES
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
BONE MARROW
CONNECTIVE TISSUE CELLS
CORTICOSTEROIDS
DOSE-RESPONSE RELATIONSHIPS
FRACTIONATED IRRADIATION
GLUCOCORTICOIDS
HEMATOPOIETIC SYSTEM
HORMONES
HYDROXY COMPOUNDS
IMMUNOSUPPRESSION
IRRADIATION
KETONES
KIDNEYS
LEUKOCYTES
LYMPHATIC SYSTEM
LYMPHOCYTES
MATERIALS
ORGANIC COMPOUNDS
ORGANS
PATIENTS
PREDNISONE
PREGNANES
SIDE EFFECTS
SOMATIC CELLS
STEROID HORMONES
STEROIDS
TISSUES
TRANSPLANTS